This is placeholder text. In the event of an error, this will be replaced with the true error message.

Required items feature an asterisk (*).

Do you need Web site technical assistance? Please complete the following information and click the 'Submit Feedback' button. For Online Provider Services (OPS) assistance, please call the TSC at 855-696-0705. If this is a customer service request, providers should contact their Provider Contact Center (PCC). Beneficiaries should contact 1-800-MEDICARE.

In order to ensure your privacy, please do not transmit any of the following information to
Palmetto GBA. Revealing this information online could expose you or others as a target for Medicare fraud and abuse.

Personal information, including Social Security numbers, which you would like to keep private.